Hi There Mr. Elephant–Let’s Talk about Health Stigma & Privilege

This post has been kicking around in my head for nearly a month now, the product of conversations with clients, chats with friends, and a professional life in the mental health field. When we are talking about the intersection of physical and mental health, we need to include a discussion about health stigma and healthy privilege. I realized as I started writing that I have a lot to say about this topic, so what started as a post will actually be a series.

This post will be to establish some basic definitions, so that we are on the same page. Let’s start with a definition of stigma:

stig·ma

noun \ˈstig-mə\: a: archaic: a scar left by a hot iron :brand; b: a mark of shame or discredit :stain; c: an identifying mark or characteristic; specifically: a specific diagnostic sign of a disease –Merriam-Webster Dictionary

Now let me share my own definition:

health stigma

The feelings of shame, isolation, self-blame and invisibility that many people facing physical or mental illness feel when others make assumptions or judgments about their ability, willpower, character, motivation, or work ethic (to name a few)–Ann Becker-Schutte’s personal & professional experiences

You may have noticed that I used language that includes physical and mental health under one umbrella. I did that on purpose, because many physical health conditions and all mental health conditions fall into the category of “invisible illness.” That means someone who is casually looking at you might not be able to see the level of pain you experience. And they probably don’t understand the effort that goes into a “normal” day. They don’t see or understand because they have some degree of what I am calling “healthy privilege.”

This definition is an adaptation from Kendall Clark’s definition of white privilege:

healthy privilege

1. a. A right, advantage, or immunity granted to or enjoyed by healthy persons beyond the common advantage of all others; an exemption in many particular cases from certain burdens or liabilities. b. A special advantage or benefit of healthy persons; explained by reference to divine dispensations, natural advantages, gifts of fortune, genetic endowments, social relations, etc.

2. A privileged position; the possession of an advantage healthy persons enjoy over persons with illness.

3. a. The special right or immunity attaching to healthy persons as a social relation; prerogative.

In addition to the formal definition, I would add this:

Healthy people enjoy the privilege of bodies that work in the ways that they expect, free from regular pain or suffering, without extraordinary effort. Healthy privilege allows healthy people to assume that their experience is “normal,” and to be unaware that coping strategies that work for them will not work for someone dealing with illness.

Here is an example of what I am talking about when I talk about healthy privilege. I have a good friend who is dealing with fatigue after chemotherapy. Some well-meaning healthy friends have told her that the response to fatigue is just to “get more sleep.” This response ignores the fact that chemotherapy puts the entire body under strain, and that strain may not be remedied with a few more hours of rest.

In the next post, I will talk a bit more about the impact of stigma, and how it can derail the effort to improve health. For now, I would love to hear more from you. The idea of healthy privilege is one that I am just starting to play around with. How do you feel about these definitions? What would you add or subtract? What experiences have you had with health stigma or healthy privilege?

This post was originally published on my practice blog and is shared here in the hopes of stimulating discussion.

Dr. Ann Becker-Schutte is a licensed psychologist practicing in the Kansas City metro area. She specializes in providing support at the intersection of mental health. If you're facing a serious illness that is affecting the quality of your life and your relationships, her mission is to support your whole health!

Thank you for discussing this. I live with depression, and I have been told I’m crazy and thus my emotions are invalid, and I’ve been given advice to exercise more or take fish oil supplements and that should surely cure it! Luckily I have created my own support system that is free from such denial of my daily challenges and empowers me without making me feel abnormal.